Sunday, August 16, 2009

MV answers: SPACES CREATED BY EXTRACTED TEETH DON'T LAST LONG

Now you might say, "my uncle had a tooth extracted and that space is still there" and you know what, you are probably right. But teeth do drift.

It's a phenomenon that dentists and orthodontists have come to depend on and something that usually comes as a surprise to patients. I'm going to explain what's called mesial drift and vertical drift.

Now you probably already understand the drift part, so let's talk about mesial and vertical. Mesial means the middle or towards the middle. Vertical means up and down.

When teeth are pulled, the mouth immediately knows something is missing and it wants to fill the gap. In mesial drift, the teeth behind the space push or drift towards the middle of the mouth. In vertical drift, the tooth that normally chews with the newly extracted tooth (opposing tooth) will look for its partner so to speak, and push or drift into the space. When a tooth comes through the gums it's called erupted. When it moves farther than it's limit it's called supererupted. Vertical drift is not the same as eruption.

Mesial drift looks like this: (notice how the tooth is slanted towards the new space)

Vertical drift looks like this: (notice how the tooth below the space is higher than the tooth next to it)



So this raises a few questions:

When it comes to mesial drift, when does it stop? When it hits another tooth, when it's stopped by braces or sometimes, it doesn't occur to the point that its noticeable.

Why does vertical drift or supererution occur? I like to think that the teeth were made to chew and as long as one tooth doesn't feel it's partner, it's going to try to find it. Teeth stop drifting vertical when they can chew against something.

If you're worried you have mesial drift or vertical drift OR if you're worried that you may experience either of these after an extraction, talk to your dentist about your concerns.


images courtesy of: www.banffcanmoredentalcare.com/cosmetic.htm and www.ijortho.ir/chapters.asp?volume=1&subject=52

jiggywiggy asks: "CAN HAWLEY RETAINERS FIX A SLIGHT OVERBITE?"

"ok so i had braces for a year and 5 months but when my braces are removed, I still have this slight overbite that I'm just totally annoyed by. Its not major, its like 3mm from the lower teeth. And now I'm wearing hawley retainers 24/7. Can hawley retainers fix this?

I'm 15 btw if that helps."



3mm is normal.

Hawley retainers are great for keeping the teeth in the same arch the braces put them in. The only movement they will allow is for any open space between the chewing surfaces of your teeth to close.

They won't correct or change an overbite but 3mm is so slight it's really not much to worry about. Now if it were 5mm or greater... then you would have a problem that the braces would've fixed.

Good job for wearing your retainer tho ;)

idk asks: "CAN I GET A BRACE THAT STRAIGHTENS ONLY ONE TOOTH?"

"my front tooth is the only crooked tooth in my mouth soo i was wondering if i could put a brace on two teeth that would straighten one tooth instead of getting a whole mouth full of metal which is totaly unnecessary."



If you have even one tooth that needs to move, other teeth around that one will need to move too, just to make space. Even if the rest are perfectly straight- they all need to move for that one tooth to fit.

As far as putting the braces on only TWO teeth, here's the problem:
Let's say you did move those teeth BUT in the process of moving those, other teeth around them were pushed by the bone reconstructing for the other two. Even if the other teeth didn't need to push away to make space, a good orthodontist would put a bracket on each tooth to make sure they moved or didn't move. Whichever was necessary.

fxyky88 asks: "WISDOM TEETH - AFTER REMOVAL?"

"I had all four wisdom teeth out last Tuesday in the hospital under G.A. Followed 'rules' very carefully and went for my follow up today at the dentist's. He did a syringe rinse and said everything looked good, no infection, no dry socket and absolutely nothing in the sockets.
Now since i've been home my gums on the bottom are very tender and I think the 'holes' are on the sides of my mouth, the top feels like that too..is that normal? My left lower lip and a bit of my chin is still numb (I know that's normal) it's just really annoying and i'm having trouble with my S's and T's when I talk, sounds like I have a lisp..can't even say lisp lol. I was taking an antibiotic for 5 days starting the day of surgery - Amoxicillin. It left my mouth and tongue covered in little white dots, oral thrush or somethin, it's a fungus and goes away on it's own, or supposed to. It's only been 2 days since I finished the bottle, the inside of my bottom lip is getting better - clearing up, but the insides of my cheeks are still the same, I would like it to clear up, i've been rinsing everyday 3 times a day with salt water and mouthwash.
When I bite down with my molars, they don't align like they used to, when I'm fully healed, will my teeth be alright? I really don't want to have any problems later on, I already need some work on my teeth and I won't be covered under my insurance anymore starting next week.
As for food, I tried to ask the dentist today what I should still stay away from but his answer was kinda vague. I know popcorn and chips and anything crunchy is a no no for a couple months at least. Nothing small like rice, nuts, seeds. But i'm really sick of eating mush everyday (mashed potatoes, pudding, soup, jello) When can I eat real food, like meat...and actually chew with my molars?"



Ok that's a lot to answer...

Thrush: Nystatin is a prescribed medication that will clear it up. Swish. Swallow.

Reason you have Thrush: the organism Candida Albicans is constantly present everywhere on our body but other organisms living nearby keep it in check. The problem with taking an antibiotic is that the normal flora that keeps Candida in check dies off and lets the Candida to go crazy. It's called a super infection. In text books it's called Candiasis, in the mouth, it's called Thrush, anywhere else its a yeast infection.

DO NOT be tempted to eat anything hard or crunchy before your jaw heals. You have giant holes in your jaw and when you crunch down, you might end up crunching your jaw in half. Meat is ok in a few weeks as long as it's soft. Cut it in tiny pieces to minimize chewing.

The molars will move a little but they'll find each other. :)

sam asks: "CAN A DENTAL ASSISTANT CROSS TRAIN INTO BECOMING A DENTAL HYGIENE?"

"im planning on becoming a dental assistant first, but i would like to become a dental hygiene afterwards is this possible?"



You can become an assistant through on-the-job training or through a school for certification

To be a hygienist however you need to go to an accredited institution and be licensed by your state. Sometimes, the program you might be applying to for hygiene will give you extra points for being an assistant beforehand but it's not like being promoted or grandfathered in.

Oh, and I hope u do great! Dental hygiene is an awesome job!

Chewy Bar asks: "ANYTHING ABOUT ELIZIBETHAN TIMES DENTAL HYGIENE?"

"Anything about Teeth or Dental hygiene in the Elizibethan era?"



The Elizabethan Era associated with Queen Elizabeth's reign from 1558–1603.

According to the timeline on the ADA's website:
1530—The Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth (Artzney Buchlein), the first book devoted entirely to dentistry, is published in Germany. Written for barbers and surgeons who treat the mouth, it covers practical topics such as oral hygiene, tooth extraction, drilling teeth, and placement of gold fillings.

1575—In France Ambrose Pare, known as the Father of Surgery, publishes his Complete Works. This includes practical information about dentistry such as tooth extraction and the treatment of tooth decay and jaw fractures.

Hope that helps :)

Sels asks: "NEED HELP WITH SPACERS!!!?"

"Ok, I got my spacers on Monday right.One of them came out on Tuesday. The orthodontist said that if it came out a day before your appointment call them, but my dad refused to take me. The next week I am going to get my braces. Do I have to wait for them just because one spacer came out. Need help. Thanks!!! Oh, I go to West Georgia Orthondontic's."



Since that spacer has only had a day- maybe less- to create any space, I doubt any space has been made... Thing is, they can't put your bracket on without any space to do it. They might put a bigger spacer in that day (bigger = more painful) and make you come back in a few days, maybe a week.

I say, put it back yourself.

It's simple (if you still have the spacer). Just thread 2 pieces of floss through it, pinch the ends of one piece together in one hand and the ends of the other piece in your other hand. That way, you'll be able to stretch the spacer by pulling on the pieces of floss. Once you can get it coordinated, gather the floss and pull the spacer so it's about the size of a tooth. Then, floss the spacer into the space it originally was. It might take a few try's but at least it'll be in there for your next appointment.

This video should help: http://www.youtube.com/watch?v=6ixDYdcccEI


Note for next visit: since you're a new patient at your orthodontist, find out what their emergency policy is. Your dad might be worried that they'll charge extra if you come back but most offices expect emergency visits throughout treatment and don't charge for those visits.

Morgan asks: "MY TEETH ARE KINDA YELLOW, LIKE THE DENTINE. I WAS WONDERING IF MY ENAMEL IS GONE & IF SO, WILL IT GROW BACK?"

"The surface of my teeth are yellow, as if the enamel has been eaten away and my teeth hurt. Can someone please give me some info about what to do and tell me if my enamel will grow back?"



1. Enamel doesn't grow back
2. If it was a serious problem with the enamel OR the dentin, you would have noticed much earlier than now

Genetic problems with the enamel are diagnosed as amelogenesis imperfecta.
In this picture, the patient has no enamel on her teeth. (The left is before, the right is after treatment, likely a fixed and/or removable denture) The dentin is not as strong as the enamel and without the enamel, it chips away.


Problems with the dentin, would be dentinogenesis imperfecta.
In this picture, the patient is missing the dentin. You can see a bit of white at the tips of the teeth where the tooth is more enamel and less dentin naturally. The enamel is weaker because of the lack of dentin underneath and can fracture more easily.

Both conditions are genetic and it would have become obvious he second your teeth came through. Both are also responsible for the loss of enamel either directly or indirectly.

Look those up and compare what you see in your mouth with the pictures available. If your teeth hurt, try to see a dentist as soon as possible.


images courtesy of: newtoncosmeticdentistry.com and mdconsult.com

Minime asks: "DRY MOUTH, HELP! (WHAT CAN I BE DOING TO STOP IT?)?"

"When ever I talk for a period of time, my mouth gets very dry and people can hear me properly. Due When I get nervous whenever I have to do a presentation or talk for long.

What should I do?"



Nerves will definitely get your mouth dry. Certain medications can do the same thing and sometimes it's genetics. It only gets worse with age so find something that works for you now.

There's a few things you can do.
1. Drink plenty of water (about 8 glasses a day)
2. Chew sugarfree gum (sugar makes you thirsty)
3. Use Biotene mouthrinse or Oasis (both are formulated for drymouth)

Inquisitive asks: "NEED HELP ON CLEAR ESSIX RETAINERS!?"

"heeey guys
soo the last time i asked a question on here i'd been to the orthodontist and been given hawley retainers, then when i went to my normal dentist last week she said that no way should i be wearing these they're doing nothing to keep my teeth straight la la la...
so she told me to wear my clear ones again (which i had to get back from my orthos assistant or whatever)

so now i'm wearing these really horrible ones with the crack and chunk missing out of it that's really painful to wear

should i listen to my dentist or call my orthodontist and see what he says? i don't wanna wear the hawley if they're not keeping my teeth properly straight...

so now i'm wearing the clear ones all day everyday cause that's what i'm used to doing now

hmm?"



Both will work.

But there's 2 ways to answer your question...

if the ORTHODONTIST got your teeth straight, HE should be the one to determine how to KEEP them straight, right? Your dentist is a dentist for a reason. Sure he may have taken classes on orthodontics and may even put braces on teeth in his office but an orthodontist has gone to school for it and my guess is the orthodontist would know better.

Here's the downside to that point. If your Essix retainers are painful, that means they're moving SOMETHING and it may very well be pushing your teeth back to where they should be. If they're really horrible with a crack and chunk missing and THAT'S what hurts, see if you can get a new set made.

Kenz H asks: "ANYONE EVER HAD A FRENECTOMY OR A TOOTH EXPOSED??? HOW MUCH DOES IT HURT?"

"Also when ur "under" how does it feel?? Like ur sleeping??? And can u feel it??? Plz tell me!!! I need one in like 20 days and idk what it is!!!"



I had a frenectomy when I was little. The tissue connecting the lip to the gums comes together in a little V and those are called frena (singular: frenum). A frenectomy is basically snipping that little bit of tissue and suturing it.

I didn't go 'under' for it. They just numbed the area. It felt like a little pinch with the first needle and after that I didn't feel anything.

I DID go under though for wisdom teeth and it was honestly like i blinked. I didn't dream or anything and I definitely wasn't aware of time passing at all. When I came to I was still really drowsy though. I couldn't drive myself home but it wasnt a big deal. I was driven home and just slept.

Laura asks: "ARE PERM. RETAINERS GOOD?"

"I'm scared to get my gap in between my teeth when I get my braces removed. I don't know anything about perm. retainers, are they worth it? Nope, I haven't talk to my ortho, yet."



Usually permanent retainers are best for people who have a lot of crowding. Since you said you're worried about getting a GAP I'm guessing they was a lot of spacing. In that case, a regular, removable retainer should be fine.

lol, you know that talking to your orthodontist is smart so definitely do that and they'll let you know what they recommend for your case specifically.

Jonny asks: :"VENEERS WITH THE DENTIST?"

"Basically my teeth are not the worst but not the best... they are in good shape without using a brace :) however i was an idiot and drank to much coke for around 4 years and consequently my enamel on my teeth has gone (not all of it but alot of it).

Luckily I have been funded to get Veneers, but because my teeth are slightly smaller than they should... does this let them put the veneer straight on without cutting anymore of my tooth away? that was my main concern?

Also how long do veneers last (if i took good care of them)?

AND if i needed them replaced would they be discounted or would i have to pay full wack for them to be replaced again cheers?

Im in the UK (if that helps) also does the NHS etc similar in America (i may be moving there within 3 years).

THANKs"



It depends on the dentist you go with, or more specifically, the veneer that the dentist will recommend for your circumstances. During the consultation he will explain the procedure and that's when you'll find out how much of the enamel will be removed. It's likely that SOME enamel (like a tiny, tiny layer) will be removed to make the surface smoother and to help the veneer adhere. But again, depends on the dentist, veneer, etc.

It's not likely that they'll last forever but if you take good care of them they can last 10 or sometimes 15 years. Replacements again are up to the dentist. If it's chipped, the whole veneer would need to be replaced but let's say the veneer just came off. If you brought it in, I'm sure it would cost less than needing a brand new one matched and fabricated.

Not sure about the NHS in the UK and whats similar here in the US but you never know. Legislation is changing over here and in 3 years it might be the same. MY recommendation is if you have the funds to do it where you are right now, at least get a consultation while the opportunity is available.

cindyd100060 asks: "HOW DO I GET RID OF AN ABSCESS W/O INSURANCE OR $?"

"I have an abcessed tooth and I took an RX of Amoxicillin 500 mg, 3x a day. Got from my Dr. I go to for my back and pay cash. Can't afford more at all. The infection did not go away. There's still a big bubble on my gum. It is NOT draining and I'm afraid it may spread into bone, blood or brain.
--Can I put a pin hole in bubble to help it drain, or will that open it up to more infection? (this is vs allowing it to stay inside}
--Also, how can I get tooth fixed with any money? Can anyone point me to a service that can help in Orlando, FL?
I think I can die from this and am getting really scared. I'm a Single Mom of 5 yr old and lost my job. Thanks for any professional info!!!"



The antibiotics the doctor gave you should definitely help the abscess but you're absolutely right. It won't go away until it can drain or the tooth is pulled.

There is a dental clinic that can work with your income. It's in Winter Garden, here's the info:
http://www.chcfl.com/locationDetail.asp?…

They charge based on a sliding scale, which means if you make a lot of money, you'll probably pay the full amount. If you're making nothing then you pay nothing. You have to prove that you were fired, any documentation like a pink slip will do. Call ahead and make sure what they need so you'll be covered. Also, they have an arrangement for emergency patients, but its like at 6am and they only take a couple of people. Sometimes there's a big line, sometimes there's only one other person. It's first come first serve.
When you call, make sure you ask about coming in for an emergency. They only take patients "in pain" so say you are.

Hope it works out well for you. In the meantime, try to keep everything super clean, brush and floss as normal, use an antibacterial mouthwash and don't share drinks with your 5 yr old. The bacteria in your mouth can transfer to others. And DO NOT puncture it yourself. It could make matters much worse.